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Ophthalmologist, oculoplastic surgeon

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Phacomorphic glaucoma

Alexey Kryvenko, medical expert
Last reviewed: 08.07.2025

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Phacomorphic glaucoma develops with secondary angle closure, mature or overmature cataract. It differs from previous pathologies in the swelling of the lens, shallow anterior chamber and closed angle.

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Pathophysiology

Phacomorphic glaucoma is a direct complication of mature or hypermature cataract with swelling of the lens and anterior displacement of the anterior segment structures. At an early stage, an increase in intraocular pressure leads to pupillary block. Then, the increasing lens displaces the peripheral part of the iris anteriorly, blocking the outflow of aqueous humor through the trabecular meshwork. Phacomorphic glaucoma is common in developing countries where surgical cataract extraction is postponed. The prognosis for vision is unfavorable: according to one study, only 57% of 49 patients with phacomorphic glaucoma retained visual acuity of 0.5 or better.

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Symptoms of phacomorphic glaucoma

Patients experience gradual or sudden loss of vision, eye pain, headache and photophobia.

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Clinical examination

The main problem is a mature or hypermature cataract with a shallow anterior chamber. The pupil may be in a state of medium mydriasis, with or without iris bombage, and the angle is closed during gonioscopy. Due to obstruction of the aqueous humor outflow pathway, intraocular pressure is elevated, and corneal edema is possible.

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Treatment of phacomorphic glaucoma

The first line of treatment is drug therapy to suppress the secretion of intraocular fluid. Miotics can increase the contact between the lens and the iris, so they should not be used. Laser iridotomy should be performed to reduce pupillary block. Iridotomy opens the anterior chamber angle, reduces intraocular pressure, and helps reduce the activity of the process before cataract extraction. In addition, it allows the doctor to examine the anterior chamber angle for anterior synechiae. The degree of scarring in the angle indicates the need for antiglaucoma surgery, which is performed simultaneously with or separately from cataract extraction. The definitive treatment for phacomorphic glaucoma is removal of the swollen lens. Staining the anterior capsule with indocyanine green facilitates rupture of the capsule on the dense lens.